Infection - Cardiomyopathy - Pericardial Effusion

40%

The m-mode tracing demonstrates which of the following?

HCM

The echo demonstrates endocardial thickening of the inflow tracts, fibrous tissue overgrowth in the apex of the left ventricle and diastolic dysfunction. These findings are most suggestive of?

Endomyocardial fibrosis

Pulsus paradoxus is defined as a > 10 mmHg decrease in systolic BP during inspiration and is commonly seen with which of the following abnormalities?

Cardiac tamponade

_____ is usually present in patients with HOCM because of the pressure changes caused by obstruction to flow leaving the left ventricle through the LVOT

MR

Which of the following would cause you to suspect cardiac tamponade?

Becks triad

Cardiac tamponade causes?

Restrictive diastolic filling

The calipers on the image are measuring?

Abnormal respiratory variation of the E velocities of the mitral valve due to cardiac tamponade

Annulus reversus is best documented using _____ and if present indicates _____

Tissue Doppler and constrictive pericarditis

In cardiac tamponade the RV free wall will collapse in diastole except in patients with significant?

Pulmonary HTN

Endocarditis affects the _____ and cardiomyopathy affects the _____

Endocardium and myocardium

Greater than 2 cm of pericardial fluid surrounding the heart indicates?

Severe pericardial effusion

A patient presents for an echo because they have been experiencing positional and respiratory variation in chest pain. You expect to find which of the following on the exam?

Pericarditis

A patient is referred to the echo lab with a 6 week history of chemotherapy treatment for hepatoma and a new onset of SOB. Which of the following is the most likely finding that will be identified on the exam?

Pericardial effusion

Which of the following is the most likely finding with radiation therapy of the left breast?

Pericardial thickening

Which of the following is not a sonographic characteristic of cardiac tamponade?

Mid systolic collapse of the RA

What is the most common complication seen with a septal myectomy that is performed to correct ASH?

VSD

Which of the following sonographic signs of HCM is not usually demonstrated in patients with isolated focal thickening in the mid cavity of the LV?

SAM of the MV

Pheochromocytomas, Friedreich ataxia and Fabry disease commonly demonstrate what echo finding?

LVH

Which of the following statements best describes the characteristics of the left ventricle with DCM?

LV dilated with decreased contractility

Which of the following is the most common type of infiltrative cardiomyopathy to develop restrictive cardiomyopathy?

Amyloidosis

A valve ring abscess is usually a sign of what cardiac disorder?

Infective endocarditis

A prominent A wave and reduction in amplitude of the systolic wave on pulmonary vein Doppler indicates?

Elevated LVEDP

Which of the following can be used to differentiate HCM from LVH caused by systemic HTN?

Pattern of LVH

Which of the following types of infiltrative disease commonly presents with a dilated LV with normal wall thickness and reduced function?

Hemochromatosis

Which of the following describes findings associated with ASH seen with HCM?

Septal to posterior wall ratio of 1.3:1 or greater

LVH and a longitudinal strain measurement of -8 indicates?

HCM or amyloidosis

The most important cardiac structure that should be evaluated in patients with suspected tamponade is?

RV free wall

A patient with conduction abnormalities, asymmetric LV hypertrophy, prominent papillary muscles and hyperechoic endocardial layer most likely suffers from?

Fabry disease

In a patient with cardiac tamponade, the IVC will?

Remain dilated with no respiratory changes in diameter

Which of the following is associated with equal diastolic pressures in the right and left ventricles

Constrictive pericarditis

A patient presents for an echo complaining of trouble sleeping because certain positions cause chest pain. The EKG report indicates widespread ST elevation. The echo demonstrates trivial mitral and tricuspid regurgitation and a mild pericardial effusion. These findings are most suggestive of?

Pericarditis

Which of the following best describes the valvular flow abnormalities seen in a heart with DCM?

Due to volume overload caused by the hypocontractile LV, the presence of multivalvular regurgitation is common

This form of cardiomyopathy typically demonstrates normal LV size, biventricular hypertrophy and significant biatrial enlargement

Restrictive cardiomyopathy

What is the most common form of infiltrative cardiomyopathy?

Amyloidosis

Which of the following is an autosomal recessive disease that involves abnormal storage of glycogen in the muscle tissues?

Pompe disease

Which type of cardiomyopathy is most strongly associated with diabetes?

Dilated cardiomyopathy

Which of the following is a way to differentiate an athletic heart from HCM?

LV wall thickness measurements

The early stages of infiltrative cardiomyopathy are commonly associated with which type of diastolic dysfunction?

Grade 1

Which of the following m-mode measurements will increase in patients with DCM?

EPSS

Asking a patient with constrictive pericarditis to take in a deep breath will cause?

Decrease in expiration of the mitral E velocity > 25%

Which of the following patients would benefit from the placement of an intra-aortic balloon pump?

Patients with DCM

The double diamond sign on a m-mode tracing of the MV is indicative of mid diastolic closure caused by?

DCM

What effect does DCM have on HR?

Increased

An intra-aortic balloon pump or a heart transplant are recommended for patients with advanced?

DCM

How does DCM affect the Doppler waveform of the pulmonary veins?

Elevated D wave with blunted S wave

Dilated IVC and HPVs are commonly associated with?

Constrictive pericarditis and cardiac tamponade

The tissue Doppler velocities of the mitral annulus cannot be used when evaluating a patient for diastolic dysfunction if _____ is present

Annulus reversus

Which of the following describes HOCM?

Peak pressure gradient in the LVOT is 30 mmHg at rest

Tachycardia, dyspnea, orthopnea and lower extremity edema are clinical findings that are most suggestive of?

DCM

Which type of cardiomyopathy is related to fatty and fibrous tissue replacement of the myocardium of the RV?

Arrhythmogenic RV cardiomyopathy

A 52 year old male enters the ER with a fever of 103 degrees and admitted history of IV drug use. He also demonstrates a recent onset of extreme dyspnea. A VQ scan of the lungs demonstrates an emboli lodged in the right bronchial artery. Which of the following is the most likely source of the emboli?

Vegetation on the TV

Which of the following causes the AV to close mid systole?

LVOT obstruction

Propranolol can be used to treat?

Subaortic stenosis caused by HCM

What is an acute, transient, stress induced cardiomyopathy?

Takotsubo cardiomyopathy

Which of the following correctly describes how to differentiate a vegetation from a papillary fibroelastoma on the MV?

Locate the point of attachment for the mass

Hemochromatosis involves excess _____ deposits in the _____

Iron and myocardium

Which of the following will lead to a decrease in dp/dt ratio?

DCM

Which of the following is an autosomal dominant disorder?

HCM

The pattern of wall hypertrophy in hypertensive heart disease is _____ and in HCM the pattern is usually _____

Symmetric and asymmetric

Which layer of the heart wall is most affected by Staphylococcus Aureus infection?

Endocardium

Which left heart abnormality will cause the aortic CW Doppler flow pattern demonstrated in the image?

HCM

The m-mode tracing is consistent with which of the following cardiac abnormalities?

Cardiac tamponade

A left ventricular myectomy is most commonly used to treat with of the following disorders?

HOCM

DCM demonstrates _____ diastolic dysfunction early on and _____ diastolic dysfunction in advanced stages

Grade 1 and 3

What m-mode changes will be identified with increased LVEDP?

B-notch on the MV tracing

The image displays a focal wall structure and motion abnormality caused by?

Focal HCM

The echo findings below are most suggestive of:

Non-dilated thick walled LV with EF 63%

E/A ratio 2.1

E/E 19

Moderate biatrial enlargement and pulmonary HTN

RVH and dilated IVC

Restrictive cardiomyopathy

A 22 year old patient presents for an echo and you identify biventricular wall thickening, mild pericardial effusion and thickening of the leaflets of all four valves. Which of the following is the most likely cause for these findings?

Amyloidosis

Which of the following describes the appearance of a mild pericardial effusion?

< 1 cm fluid located posterior to the heart

Which of the following is present not he image?

Mild pericardial effusion and moderate pleural effusion

HCM will usually cause what change in brachial blood pressures during treadmill testing?

Decrease in systolic nad diastolic pressure

Which of the following is the typical treatment for advanced pericarditis?

Pericardectomy

Respiratory variation in the isovolumic relaxation time is usually a sign of?

Constrictive pericarditis

Which of the following will cause an increase in the murmur associated with hypertrophic subaortic stenosis?

Amyl nitrite administration

A 42 year old male presents for an echocardiogram 2 weeks post pericardectomy due to constrictive pericarditis. What is an expected finding on the exam?

Increased cardiac motion at rest

On the parasternal views, you identify an isolated 1.5 cm nearly echo free space anterior to the RV that does not change dimension with cardiac motion. Which of the following describes this finding?

Epicardial fat pad

Mid diastolic closure of the MV may be seen with which of the following abnormalities?

DCM

A patient presents for an echo after a recent diagnosis of Chugs disease. What are you looking for on the exam?

DCM and apical aneurysm

Electrical alternans is a common finding in which of the following abnormalities?

Cardiac tamponade

Which of the following lists an expected finding on tissue Doppler evaluation of the septal annulus in a patient with constrictive pericarditis?

E’ = 10 cm/s

An m-mode tracing of the MV records normal motion with a shaggy appearance of the anterior leaflet in all phases of the cardiac cycle. Which of the following is the most likely cause for this?

Vegetation formation

Which of the following presents as heart failure with a preserved EF% and significant diastolic dysfunction?

Restrictive cardiomyopathy

_____ is the preferred method of diagnosis of constrictive pericarditis

Cardiac catheterization

The Doppler tracing of the LVOT seen with HOCM is said to resemble?

Dagger

What type of infection only affects the cardiac valves with no involvement of myocardium or other cardiac structures?

Marantic endocarditis

Which of the following is the most likely EF% on a patient with DCM?

15%

Which of the following describes the appearance of the Doppler tracing of the MV in a patient with restrictive cardiomyopathy due to amyloidosis?

Higher peak velocity of the E wave and a very low peak velocity of the A wave

A cardiac murmur is auscultated with the patient supine. The murmur gets louder when the patient stands next to the table. These findings are most suggestive of?

HCM

Chest pain increasing at night and dyspnea accompanied by a “knocking” sound with auscultation are clinical findings that are most consistent with?

Pericarditis

Which of the following valvular abnormalities is commonly associated with the abnormality on the image?

SAM

The most commonly identified cause of DCM

Alcoholism

Refers to an arterial pulse waveform with alternating strong and weak beats

Pulsus alternans

Diastolic flow reversal in the HPVs, diminished S velocity and prominent. A wave on the pulmonary venous tracing with a mitral E/A ratio of 1.9 correlates with which of the following?

Constrictive pericarditis

Which of the following types of regurgitation is usually the first to develop with DCM?

Mitral

The Doppler tracing is consistent with which of the following cardiac abnormalities?

Constrictive pericarditis

An alcohol induced septal ablation is used to treat which of the following cardiac abnormalities?

HOCM

Which of the following is an expected EF% on a 25 year old patient with HCM?

85%

Which of the following is the most common method of treatment for a patient with cardiac tamponade?

Pericardiocentesis

Which of the following will demonstrate a below normal EPSS measurement?

HCM

How does restrictive cardiomyopathy affect pulmonary venous flow?

Blunted systolic velocity and increased diastolic velocity